This is Cesarean Awareness Month, and since 1 in 3 babies are born by cesarean I want to address what cesarean birth is like for families who are expecting their baby to be born surgically. First I’d like to clear up a few things terminology wise:
When you know in advance
- Breech Birth
- Repeat Cesarean
- Placenta Previa
- Personal choice
When the need arises in labor, but there’s time to decide
- Active herpes lesion
- Labor does not progress
- Baby not descending when pushing
- Induction not working
When something goes wrong and every second counts
- Severe fetal distress
- Placenta abruption
- Failed vacuum or forceps
- Cord prolapse
For this article, I’m focusing on planned cesarean birth and most unplanned cesarean births. There is a lot of variation from hospital to hospital about the details, but the overall process is pretty similar from place to place.
Step 1: The decision
This can be either before or during labor, and there are so many possible reasons and causes that there’s no way to address it in this post. Just know that you can carefully consider your options and use your BRAIN to look at the Benefits & Risks of the cesarean, the Alternatives (and the benefits and risks of those), listen to your Intuition, and consider what happens if you do Nothing, too.
Step 2: Birthing Day!
If you’re already in labor at the hospital, this part’s easy. If you’re laboring at home or at a birth center, you’ll need to transfer to the hospital, and your midwife can help you navigate that. If it’s a scheduled cesarean they’ll give you a time. They may have you just show up at that time, but often that’s a time to call in and make sure it’s clear. Usually it is, but I’ve had clients be in a holding pattern for much of the day because labor and delivery was unusually busy that day.
Once you get to the hospital, you’ll be admitted and moved to a labor and delivery room.
Step 3: Preparing to Go to the Operating Room
In your labor and delivery room, they’ll have you change into a hospital gown, get an IV started, give you an antacid in case of nausea, and use clippers to trim your pubic hair really short. Shaving isn’t recommended because the small microscopic cuts can increase infection risk.
Most hospitals are good with one person accompanying you in the operating room. As part of the preparation, they will give the partner something to change into. A few hospitals will give your partner scrubs to change into, but most use lightweight jumpsuits that go over regular clothing (they’re semi sheer, so definitely wear clothes under!), along with shoe covers, a hat and mask.
When everyone is all ready to go, they’ll move you to the operating room. This might be by bed, wheelchair, or you might even walk. Chances are your partner will wait just outside the operating room during step 4, and then join you when it’s time to start the surgery. But you can definitely advocate for having their support during this time if you want it!
Step 4: Preparation in the Operating Room
Nearly all planned cesareans are done with some form of a spinal block, which leaves you awake and aware for the birth. If you don’t already have an epidural, the first step in the operating room is do give you a spinal. This is very similar to the epidural as far as the area it numbs and how it feels. It does not have the small tube to deliver medication continuously, though, because they know the surgery won’t take long. They give you medicine to numb pain for about 2 hours, and sometimes a longer lasting medication to dull the recovery pain for the first day or so.
They’ll get you settles on the operating table. It’s quite narrow to allow the surgeons to be able to get in close to where they are working, so in order to make sure you don’t fall off, your legs and torso will be strapped into place. Most operating tables have smaller narrow tables for your arms. In my experience, most hospitals are not strapping down people’s arms for cesarean birth any more, thankfully.
Your partner will be able to sit by your head, and an anesthesiologist or nurse anesthetist will be sitting on your side. Their job is to support you and keep an eye on how you are doing during the surgery.
A paper drape will be put up at about your armpit level. It will block your view of the surgery. If your partner wants to see, they can easily stand to watch. If you both want to see, you can request a clear or clear window drape to see the birth of your baby.
The staff will wash your belly with a cold antiseptic solution and put drapes over your body all around. Your legs will be covered so you stay warm.
Step 5: The surgery itself
There are usually two people doing the operation. The surgeon/obstetrician and an assisting doctor. Occasionally a CNM might be assisting as well. They stand opposite each other across your belly.
The vast majority of cesarean births are done with a low transverse incision. This makes for a stronger scar in the uterus that makes future pregnancies safer. First they cut through the skin and then work their way down through various layers, and when they get to the uterus, they cut a similar incision in the uterus.
Once the uterus is open, they break the amniotic sac and bring the baby out. Whatever part of the baby is closest to the incision is the part that comes first. After the baby is out, one of the surgeons will clamp and cut the cord. (Because they’re not scrubbed in and sterile, partners don’t generally get to do this with cesarean birth.)
Usually the doctor will hold the baby up over the drape for the parents to see, before passing the baby to the nurses who will check over how the baby is doing. If there is concern about how the baby is doing, there will be doctors there as well. Usually it’s fine for the partner to go over to the warmer and see the baby at this point.
If all is well with the baby, many hospitals will bundle the baby up and have the partner hold the baby while sitting next to the operating table. Both parents can see, touch and talk to the new baby during this time. Some places will do skin to skin with the partner or (less commonly) the person having surgery, but often that has to wait until you’re recovering.
While all of that is happening, the surgeons will separate the placenta and bring it out through the incision. When the uterus is empty, they stitch back up the uterus and start putting the layers back together, eventually closing the skin. Surgical staples are a common way to do this, though some still use surgical glue and/or stitching. A bandage is taped over the incision, and all the drapes start coming down as they prepare to send you back to the labor and delivery room or to a dedicated recovery room.
Step 6: Back to the rooms for Recovery
Once you’re in the recovery room, you will probably have the chance to get skin to skin with your baby and an opportunity to breastfeed. Some hospitals don’t allow this in recovery, but in my experience most do IF there is a competent adult to stay with you the entire time and make sure you don’t drop the baby.
You may or may not have pain at the incision at this point. Use lots of pillows and get help moving yourself into a comfortable position before holding your baby. If you want to breastfeed but have incision pain, you can use the football hold to nurse your baby.
You may feel just fine at this point, or you might have some grogginess and feel weak. If you’re not up for skin to skin yet, that’s fine. The time will come.
Recovery In the Days and Weeks Afterward
Remember you are recovering from both birth AND major abdominal surgery. You’re also learning how to parent this baby. Even if you’ve had babies before, a new one is always an adjustment and learning curve. Get up and walking as soon as you are able, as this helps with healing and with getting your bowels moving again.
Brace your incision with a pillow of your hand before you sneeze or cough. Find feeding positions that are comfortable and don’t put pressure on your incision. Stay on top of your meds, as it’s easier to keep pain low than it is to lower it once it increases.
Be gentle with yourself. Take all the help you can get, particularly in the first few weeks you are home. When people ask “is there anything I can do?” say yes! A postpartum doula can be invaluable!